Related Experiment Videos
[Aortic dissection after aortic valve replacement: clinical and anatomic features]
P Presbitero1, E Aruta, F Rabajoli
1Divisione di Cardiologia, Ospedale S. Giovanni Bosco, Torino.
Insights
Ascending aortic dissection can occur after aortic valve replacement surgery. Early detection and consideration of ascending aorta replacement are crucial due to high reoperation mortality rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Cardiac surgery, specifically aortic valve replacement, presents a risk for ascending aortic dissection.
- A study reviewed 134 patients with aortic dissection, focusing on 12 who previously underwent aortic valve replacement.
Purpose:
- To evaluate the incidence, clinical, and anatomical features of ascending aortic dissection following aortic valve replacement.
- To assess the outcomes of reoperation for this complication.
Summary:
- Ascending aortic dissection occurred in 0.66% of patients after aortic valve replacement, with a mean aortic diameter of 4.92 cm.
- The interval between procedures varied, and reoperation carried a significant mortality risk (50% at 12 months).
Impact:
- Highlights the need to consider ascending aorta replacement if aortic root dilation is present during aortic valve surgery.
- Emphasizes the importance of identifying high-risk patients for ascending aortic dissection post-valve replacement due to elevated mortality.
Background:
Cardiac surgery has become a possible cause of ascending aortic dissection, particularly in patients who have undergone aortic valve replacement.
Methods:
From January 1979 to December 1989, 134 patients with angiographic evidence of aortic dissection, were studied in the Haemodinamic Laboratory of the University of Turin. Twelve of these patients (7 men and 5 women), mean age 51.6 years, had been previously operated for aortic valve replacement. We evaluated incidence, clinical and anatomic features of ascending aortic dissection in this group.
Results:
A dilated ascending aorta with a mean diameter of 4.92 cm. was noted in all these patients. The interval between valve replacement and diagnosis of aortic dissection was 57 months (range 1 day to 9 years). Reoperation was performed in 11 patients. Four intraoperative deaths occurred and 2 other patients died in the early post-operative period. Survival rate at 12 months was 50%. Our incidence of ascending aortic dissection after aortic valve replacement was 0.66% (10 patients out of 1499 operated for aortic valve replacement) and it is in agreement with reports from other Authors in literature.
Conclusions:
Replacement of the ascending aorta must be considered if an important dilatation of aortic root is found at time of aortic valve surgery. New efforts must be undertaken to identify patients at high risk for this complication because an elevated mortality rate is observed in reoperation for aortic dissection.